Scottish Parliament Mental Health Debate, September 28Th 2011

Scottish Parliament Mental Health Debate, September 28th 2011

The Minister for Public Health (Michael Matheson):I am pleased to open the debate on behalf of the Government. As the motion says, “significant progress has been made in mental health services, mental health improvement and mental health law in Scotland”. That progress reflects the priority that the Scottish Government and the Parliament have given to mental health since devolution. However, as the motion also says “there is still work to be done”.
We have recently published our consultation document on a new mental health strategy for Scotland, which is intended to build on previous and continuing work and to establish the priorities and actions for the next four years. There will be many opportunities for service users, carers, providers and professionals to engage with that consultation and to shape the agenda for the next few years. I will also be interested to hear members’ views in the chamber this afternoon.
I will start with a few brief comments about the reports in the press over the past 24 hours relating to antidepressant figures. First, it is clear that there is a general misunderstanding of the relationship between prevalence and defined daily doses. Although the figure for defined daily doses has risen, the evidence from research is that the number of people who are taking antidepressants is not increasing. Secondly, the evidence is that general practitioners are prescribing appropriately and in accordance with clinical guidelines, often in conjunction with psychological therapies but also for longer periods, which is consistent with those guidelines. The Royal College of Psychiatrists and the Royal College of General Practitioners have previously raised that as a matter of concern with Opposition parties and will make further representations on it.
It is not possible, in a brief debate, to capture all the work that has been undertaken over the past four years—and, indeed, in the period before that—but I will touch on some of the main achievements. In the previous session of Parliament, we made the commitment, as part of the national health service health improvement, efficiency, access and treatment—HEAT—targets, that we would improve the speed of access to specialist child and adolescent mental health services. We said that, by March 2013, no child would have to wait more than 26 weeks to begin treatment. That commitment was made against a backdrop of different levels of performance throughout Scotland, both in speed of access and in the number of children being seen by specialist services. Some children and young people are seen very quickly, but we know that others wait far too long to receive the care that they require.
We have been working closely with NHS boards and other partners to develop information systems and referral pathways and to increase workforce capacity. We are confident that we will achieve the target by the set date. We know that earlier action is likely to have better outcomes and offer a benefit to children, their families and the health service overall. We have also supported the target with new investment to increase the specialist child and adolescent workforce. In 2011-12, that new investment equates to £5.5 million of ring-fenced money for specialist services, and that money will continue across the spending review period. It is a long-term investment in our children and young people.
We are growing the specialist workforce. I can report a 33 per cent increase in the specialist workforce between the end of 2008 and March 2011, and we will ensure that the increased workforce capacity is maintained over time. That increase in workforce means that more children and young people are being seen and that they are being seen more quickly.
Progress has been made on reducing the number of young people who are admitted to adult wards. Such an admission is an appropriate decision in some circumstances, but that is not always the case. When the 2010 Mental Welfare Commission for Scotland figures are published shortly, they will show an improvement of 18 per cent on the 2009 figure, but performance is not acceptable. I have asked for further work to be done to ensure that children and young people are always admitted to an appropriate location.
Dr Richard Simpson (Mid Scotland and Fife) (Lab):I understand why the minister quotes percentages all the time, but the hard figures would be a little more meaningful and would be helpful.
Michael Matheson:I appreciate that, but the figures are unpublished. In general, they will show an 18 per cent drop nationally in the number of young people who are admitted to adult wards.
We have taken forward the agenda that is set out in “Towards a Mentally Flourishing Scotland: Policy and Action Plan 2009-2011”. That work covers the social inclusion of people with mental illness, the prevention of mental illness and the creation of good mental health. The agenda is challenging but it is one for which Scotland is well regarded. We have delivered our commitment and I will briefly mention three areas of work that have been covered.
Our work to tackle stigma through our continued financial support of the see me campaign has been highlighted by the European Union as good practice and a demonstration of how national Governments can tackle the issue successfully. We will continue to work on that and we are considering how to take greater account of discrimination as well as self-stigma. Service users and their families will continue to be key to that work.
Since 2008, the suicide rate has reduced. The figure for 2009 was the lowest for 20 years, and the 2010 figure was also one of the lowest for that period. Between 2000 to 2002 and 2008 to 2010, the suicide rate in Scotland reduced by 14 per cent. That is progress, but there is more work to do, and we will continue to develop evidence-based approaches to the issue.
Progress on reducing suicide is a testament to the choose life programme and to the excellent local clinical work to tackle depression and alcohol abuse and to support the management of people with long-term mental illness. We met our target that 50 per cent of all front-line staff would receive appropriate suicide awareness training.
People with mental illness tend to die younger and generally from physical health conditions such as heart disease and diabetes. The work that we have done to improve the physical health of people with mental illness has resulted in patients receiving regular physical health checks and being supported in developing healthy lifestyles and in tackling issues such as smoking and diet. That will continue to be part of our work to deliver excellent clinical outcomes and to support patient safety through effective medication management.
As the first Government to establish dementia as a national priority, we published “Scotland’s National Dementia Strategy” in June 2010, which set out two key priority areas, as well as commitments to action. Work to deliver the strategy is being progressed with health boards, local government and organisations such as Alzheimer Scotland.
We have exceeded our target to increase the number of people with dementia who are properly recorded on GP registers. Diagnosis leads to better information and support, physical health checks, medication when that would offer a benefit, and support for carers. We are considering how we can improve and enhance post-diagnostic support, with learning from the pilots that have just concluded, and how we can offer that service in a way that meets the needs of people with dementia and their carers.
Mary Scanlon (Highlands and Islands) (Con):I very much welcome the dementia strategy, but I do not see alongside it the commitment to training and to ensuring staff awareness and understanding of dementia.
Michael Matheson:We continue to take forward the dementia strategy. An annual report was published in September this year, and a further annual report will be published next year on the progress that we have made, so the Parliament will be able to check what progress has been made.
We will continue to focus on two change areas: the provision of excellent support and information to people with dementia and their carers after diagnosis, and improvement of the care of people with dementia in general hospital settings. In particular, I am grateful for the support from the Mental Welfare Commission for Scotland, NHS Education for Scotland, the dementia service development centre at the University of Stirling and Alzheimer Scotland, which have assisted in taking the work forward.
In the consultation document, we identify four broad areas of activity in which we believe we can have a significant impact on outcomes. In each case, the focus is on a particular target or objective, but we believe that the work will have broader benefits in integrating services and producing change. I have already mentioned work in two of the areas of activity—suicide reduction and dementia—but I also want to say something about our work on access to therapies and service structure.
We are committed to meeting our target to deliver faster access to mental health services by delivering the 18-week referral to treatment for psychological therapies across all age groups from December 2014. On the face of it, that seems to be a clear and simple undertaking that can be agreed on all sides, but reworking how a complex system operates involves significant effort over time. We must also remember that the work on access to psychological therapies is just one part of creating a well-functioning mental health system. In parallel with that, boards and their partners will offer access to information and advice, self-help approaches—some of which will be online or given through NHS 24—bibliotherapy, counselling and other accessible low-intensity treatments, including exercise, to meet the needs of those who are experiencing psychological distress.
We propose work to look further at the structure of services for people with severe and enduring mental health problems. During the last session, we undertook work to reduce readmissions, and we significantly outperformed our target. We also considered crisis and first-contact services. During the next period, we propose a more structured examination of first-contact, crisis, community and in-patient services to develop recommendations for service redesign. We now have better benchmarking information about mental health services than we have ever had before, and we have experience of and expertise in local service redesign. It is time to capitalise on the information that we have and to develop our understanding to improve services more effectively.
The consultation on the draft strategy is open until the end of January 2012. I encourage members to engage in the consultation exercise; I also encourage them to encourage local organisations that work in the mental health field to engage in it to ensure that we have priorities that meet the needs of people with mental health problems in the years ahead.
I move, That the Parliament recognises the significant progress that has been made in mental health services, mental health improvement and mental health law in Scotland, but notes that there is still work to be done and in that regard welcomes the publication by the Scottish Government of a consultation document on a new mental health strategy for Scotland that builds on previous and continuing work and establishes the priorities and actions for the next four years in support of a healthier and fairer Scotland.
Dr Richard Simpson (Mid Scotland and Fife) (Lab):I declare that I am a fellow of the Royal College of Psychiatrists and I have an honorary professor appointment in psychology at the University of Stirling.
I agree with the minister that there is not enough time in the debate to cover in detail the full panoply of mental health. My party and I very much welcome the consultation, but I gently point out to the minister that his referral to the suicide rate in his written introduction to the consultation is slightly misleading because, as he sort of hinted, the suicide rate is again rising after a prolonged slow fall.
The consultation document refers to 14 high-level outcomes and has 35 questions, but it focuses on four particular areas. I want to cover some of those areas, although colleagues will go into greater detail.
The Government has set new targets for psychological therapies. That is welcome, but I cannot but reflect that the dropping of the target to reduce antidepressant medicine levels perhaps came just in time to slightly alleviate the Government’s embarrassment about the very large rise in overall prescribing that has occurred. No matter what the minister’s explanation is about daily doses and so on, antidepressant medicines are still being used extensively for the treatment of moderate to mild depression rather than only for moderate to severe depression. The inability to provide adequate numbers of psychological therapies at present, which I understand is a capacity issue, means that those medicines are still being used more extensively than they should. My colleague Mary Fee will have a bit more to say on that.
Dementia has been quite rightly identified by the cabinet secretary and the Government as a particular area of concern, and I welcome the work to achieve early diagnosis and good information for patients and carers. I applaud the continuing work of the world-class, internationally renowned dementia services development centre at the University of Stirling. The information, support and training that it provides make a major contribution to the management of dementia in Scotland, the United Kingdom and beyond. However, I am concerned that the impact of this centre of excellence could be diluted by spreading the funding to develop expertise to other Scottish universities that, hitherto, have had little expertise in the field. I am not convinced that new players will be able to deliver the training that is vital to achieve the response to dementia in general hospital settings that the minister and I both want.
The suicide reduction target towards which some progress was being made is now in serious danger of failure. I wonder how long it will be before that target is also dropped. I have made freedom of information inquiries to find out whether the removal of ring fencing from the choose life programme has led to a reduction in funding, and indeed it has. The Government has a duty to at least audit that in light of increases in suicide rates. Some local authority expenditure is being replaced by NHS expenditure but, nevertheless, the fact is that that money was given to the local authorities for that purpose. Attempts were made to reduce the funding in the Western Isles which, in view of its small population, has one of the highest suicide rates. That is of concern.
According to evidence from Professor O’Connor at the University of Stirling, self-harm in teenagers is running at 14 per cent. Its prevention requires a whole-system approach, so I will concentrate much of the remainder of my speech on early years, childhood, adolescence and young adulthood, which are stages at which, as the Government’s paper says, we need to respond quickly and improve short and long-term outcomes.
We have had two expert reports that indicate clearly what the Government’s general direction of travel should be. The Christie commission clearly pointed to a major shift to prevention and was in line with the work of the chief medical officer, Sir Harry Burns, on early years and children. I believe that, with limited resources, it is necessary to focus any new resources on children and young people
We need to tackle the issue of mental health in the antenatal and post-natal stages. Issues ranging from serious and enduring illness to problems with drugs and alcohol and post-natal depression all contribute, if untreated, to a poor start for the child. At present, mothers are discharged from supervision in the post-natal phase at around eight weeks, whereas post-natal depression maximises at twelve weeks. That is a problem. Treating those adults—ensuring not only that any mental illness is diagnosed but that the mothers achieve the highest level of mental wellbeing—is critical to a good start for the children.
We know that about 125,000 young people in Scotland experience mental health problems that interfere with their daily lives. How many of those cases could be prevented if the measures that I have outlined were put in place?
I believe that four groups should be given greater prominence in the strategy. The first is looked-after children, around 50 per cent of whom will have a mental health problem. That is a significant area. As we know, the number of looked-after children has grown from just over 11,000 to nearly 15,000. It is an increasing problem for us. The second group is children of offenders in custody, who are at particular risk. The third group is pupils in primary settings who face general familial problems, rather than those problems that require the intervention of the specialist child and adolescent mental health services. The fourth group is young offenders.